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medica procedures > wound healing and would care > Flashcards

wound healing and would care Flashcards

1
Q

Inflammatory phase

A

bodys initial response to injury
stop bleeding–> fibrin platelet clots attract RBC’s into matrix clots
48 hrs after wound–> monocytes invade wound; release growth factor to continue wound healing

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2
Q

what phase of healing begins 72 hours after injury

A

prloliferative phase

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3
Q

proliferative phase

A

fibroblasts provude structure to wound via collagen

wound will be impervous to water

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4
Q

what phase begins at 2-3 weeks after wound

A

remodeling phase

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5
Q

how long does remodeling phase take

A

up to 2 years

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6
Q

what occurs during remodeling phase

A

high levels of collagen, wound is 70% of normal skin strength

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7
Q

what can happen if the inflammatory phase of wound healing is too long

A

a keloid scar

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8
Q

what is wound contraction and when does it occur

A

the natural process of the body pulling normal skin over the wound, it aids in closure
its faster in areas where skin is loose
it occurs druing the first week of healing (remodeling phase)

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9
Q

when does epithelialization occur

A

during the inflammatory phase

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10
Q

what is epithelialization

A

dermal soft tissue repair
keratinized epithelium forms a barrier to water
-wound can now be exposed to water
with injury to the dermis, would will heal this way

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11
Q

primary healing

A 
healing by first intention
early debridment & suturing-->optimal healing
-wound edges are directly approximated
-lower layers closed
-needs to be closed in under 24 hrs
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12
Q

secondary healing

A

healing by secondary intention
wound left open, heals spontaneously from edges towards center of the wound
usually packed with iodine packing–> closes from bottom up–> prevents bacteria from growing at the bottom

not as satisfying of a cosmetic result

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13
Q

Tertiary healing

A

healing by third intention

closed after a delay of days-weeks

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14
Q

factors related to the wound that affect healing

A

nature of the wound, laceration/crush
treatment within golden period
presence of hemotoma and level of contaminination
blood supply to area

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15
Q

why is a hematoma bad for wound healing

A

it acts as a medium for infections to grow on

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16
Q

factors related to the pt that affect wound healing

A 
over 60
DM, collagen or vascular dz, anti clotting meds
immunosupressed
nutritional status
use of steroids/chemo
edema
immunizations up to date (tetanus)
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17
Q

abrasions

A

loss of superifical epitheloum
dermis is intact
need to clean carefully

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18
Q

contusion

A

soft tissue swelling/hemorrhage
skin intact
rarely requires aspiration

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19
Q

Laceration

A

cut
needs to be debrided (remove devitalized tissue
often suture closed

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20
Q

avulsion

A

loss of tissue, under minign flap
debride, suture of blood supply is ok
t

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21
Q

Puncture wounds

A

what happends underneath is often worse than what you see superficially, need to make sure there isnt a foreign body isndie

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22
Q

crush injury

A

extensive injury to underlying structures
need to debride skin flaps
IV fluorescein can be helpful to check the interstitial capillaries

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23
Q

what can epi be used for

A

stopping the bleeding

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24
Q

where cant it be used

A

fingers
toes
noes
penis

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25
Q

what is usually used as a local anesthetic

A

xylocaine .5% or 1%

26
Q

what do you use to irrigate the wound

A

NS 20’cc from large bore needle

27
Q

what does debridment do

A

removes debris, clots, and necrotic tissue

28
Q

what can be used to stop the bleeding (hemostasis)

A

cautery or ligate bleeders

29
Q

which sutures are the most reactive with tissue and cause the most inflamation

A

biologic (cat/sheep gut)

30
Q

what is a new and better option for biologic/absorbable

A

vivryl or dexon

31
Q

what is most often used in surgery to close incisions

A

staples

metal is inert, very low reactivity

32
Q

what would get you the rail road tract appearance

A

if the sutures are too tight

causes ischemia, the ischemia causes inflammation which causes the rail road track appearance

33
Q

what 3 things should dressings be able to do

A

provide compression
absorb secretions
protect form inadvertent injury

34
Q

what is the strength of a wound after 1 week?

A

3% of normal skin strength

35
Q

what happens if sutures are left in for over 1 week?

A

get poorer cosmesis

36
Q

what makes for less risk of infection

A

good debridement & lavage

closed by primary intention

37
Q

what classifies a wound as significantly contaminated

A

contaminated with bacteria at 100k col/gm of tissue

38
Q

what is the most important element to reduce bacteria colony count?

A

debridement

39
Q

how frequently should dressings be changed

A

TID every day

40
Q

what agents can be used to reduce colony counts in contaminated wounds

A

topical silver sulfadiazine

41
Q

what classifies a wound as infected

A

> 100k colonies per gm of tissue

often colonized by staph

42
Q

how would you tx an infected wound

A

deligent debridement/frequent dressing changed and topical silver silfadiazine

43
Q

what are 3 causes of chronic wounds

A

venous insufficiency (venous stasis)
diabetic foot ulcers (poor neurovascularization)
pressure sores

44
Q

how long will epithelialization take if the wound is well approximated

A

24 hrs

45
Q

why are scars visible

A

residual disorganized collagen

46
Q

what must exist for wound contraction to occur

A

fibrinonectin and collagen matrix framework must exist

47
Q

how does a partial thickness wound heal

A

by epithelialization

48
Q

how fast does epithelialization occur in partial thickness wound?

A

1-2mm/day

49
Q

how fast does epithelialization occur in an open, full thickness wound?

A

1-2 cm/month

50
Q

why is new epithelium so sensitive?

A

because it takes a very long time for it to form its anchoring (hemidesmosome attachments) to the basement membranes, which is how epithelial cells get their strength

51
Q

how can you avoid suture marks (rail road tracks) and also not disrupt the wound/reopen the incision which only has 3% of the normal skin tensile strenght at 1 week?

A

use subcutaneous stitches which will dissolve and not have to be taken out

52
Q

what is the wound strength at 3 weeks?

A

10%

53
Q

what will happen if a small amount of blood/eschar is left on the surface of the wound/incision

A

bacteria will adhere, grow, and delay epithelialization

54
Q

how much strength do wounds have at 6 weeks?

A

35-50% of prewounding strength

55
Q

how is debridment accomplished?

A

surgery

56
Q

what vitamin is necessary for collagen synthesis

A

vitamin c

57
Q

in pts taking steroids, what vitamin can help speed up wound healing?

A

vitamin a

58
Q

what kind of abx propholaxis do you use in class 2 wounds

A

first gen cephalosporins

59
Q

what kind or abx prophopaxis do you use in class III wounds

A

second generation cephalosporins, or ampicillin/gentamycin/flagyl

60
Q

when abx do you use in pcn allergic pts or in pts with MRSA

A

vancomysin

61
Q

necrotizing fasciatis

A

life threatening
involves different fascial layers of the body
caused by streep or staph
occurs in contaminated soft tissue injuries, esp in pts with DM or peripheral vascular dz

medica procedures (3 decks)

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